Will the Pfizer and Merck pills move COVID-19 into endemic status?

From my inbox this morning:

Pfizer’s pill is the second to show significant effectiveness against COVID-19; Merck also has one that’s waiting for authorization from the FDA. Are these pills the next step toward moving COVID-19 from pandemic to endemic status?

A quick definition of our terms might be useful here:

  • A pandemic is a widespread outbreak of a disease, affecting multiple countries and their populations. The growth of the disease is exponential and there are few, if any, known preventive measures that can be taken against it.
  • An epidemic is an unexpected increase in disease cases in a specific geographic region. Epidemic diseases don’t have to be contagious; obesity and other health-related behaviors, such as smoking, can also be considered to be epidemic.
  • An endemic disease is one that is consistently present (like measles or influenza); in other words, it isn’t fully (or nearly fully) eradicated. There may be flare-ups in specific regions occasionally, but overall, the disease can be managed with existing preventative measures (as simple as effective hand-washing but also including the use of vaccines) or palliative measures (such as pharmaceuticals designed to alleviate the effects of the disease after it was contracted).

COVID-19 remains a pandemic. We have preventative measures, specifically several vaccines, that are proven to greatly reduce the chance of contracting the coronavirus that causes COVID-19. And those same vaccines also greatly reduce the severity of the illness, including nearly eliminating the chance of hospitalization and death, if someone gets COVID-19 in a “breakthrough” infection. To reach endemic status, as many people as possible need to be vaccinated or develop enough resistance to future infections from already having a COVID-19 infection (which doesn’t happen in every case, making getting a vaccination even after having COVID important).

Vaccinations have plateaued in the United States. According to CNN Health, the U.S. is 57.0% fully vaccinated, with an additional 9.1% having at least one dose administered to them. Among the G-20 nations that report overall vaccination percentages, the U.S. is twelfth, just behind Turkey and ahead of Mexico. (The table doesn’t include the European Union, which is the 20th G-20 member; or Brazil and China, which don’t report vaccination percentages for their populations.)

RankCountryFully vaccinatedOne-dose onlyTotal at least partially vaccinated
1South Korea76.2%4.5%80.7%
6United Kingdom67.1%6.4%73.5%
9Saudi Arabia61.4%7.3%68.7%
12United States57.0%9.1%66.1%
17South Africa21.0%4.9%25.9%
COVID-19 vaccination rates for G-20 countries (Source: CNN Health)

Considering the enormous advantage the U.S. when vaccines first became available last winter, it’s frustrating to see how far behind we are in getting people vaccinated. But is that really unusual? Leaving aside politics (admittedly a difficult thing to do these days), we’re historically averse to getting vaccines that aren’t required by law: in 2019-20, just as we were becoming aware of COVID-19, only 51.8% of Americans six months and older got that year’s readily-available influenza vaccine, according to CDC data. Our current COVID-19 vaccine rate of 57% is just slightly higher than that figure.

COVID-19 has declined again across most of the U.S. As of November 3, there are hotspots in Minnesota, Colorado, Arizona, New Mexico, and parts of Maine, New York, Michigan, and Alabama. But it’s nothing like early September, when infections were rising nearly everywhere. While the college where I’m employed requires masks inside campus buildings, in the rest of town it’s very rare to see anyone wearing a mask in a restaurant, grocery store, or other retail business. Yet our numbers remain low, including the Rt number I’ve discussed before.

If the pills from Pfizer and Merck can be rolled out and the costs aren’t prohibitive (not a safe assumption, unfortunately), we might reach a place where, like the flu, at least a slight majority of people have chosen to get a vaccine and those who don’t have a simple, effective remedy. At that point, the realistic goal of turning COVID-19 from a pandemic to an endemic disease could be in sight.